From Little League to Major League

March 2, 2014

The most important factor predisposing young players to injury is overuse, with pitch types and positions played also contributing. When players, parents and coaches are well informed about the risk factors, the likelihood of injury can be reduced.

The American Sports Medicine Institute has identified some particular factors that predispose a young baseball player to injury.

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They include pitching more than eight months in a year, pitching on back-to-back days, pitching for more than one team in the same season, pitching more than one game in a day and playing pitcher and catcher on the same team.

The American Orthopedic Society for Sports Medicine is currently sponsoring a study looking at 700 pitchers ages 9-18.

Forty percent of the pitchers reported pitching in a league without a pitch count or innings limit, 57 percent pitched on consecutive days and 33 percent pitched on more than one team during the same season. While the guidelines for overuse can greatly reduce injury, they may not be followed appropriately.

To manage overuse, Little League baseball has implemented pitch counts while USSSA baseball has enforced inning limits. However, if a player is in both leagues, there is little communication between the two, often resulting in overuse. Ultimately, the more a player pitches, the greater the risk of injury.

A study in Sports Health surveyed coaches to see how compliant they were with following pitch-count rules.

Surprisingly, only 43 percent of coaches correctly answered questions about pitch-count rules. Another 27 percent of coaches admitted to not following the guidelines given, with 19 percent reporting pitching a player that reported shoulder or elbow soreness or fatigue. Only 53 percent of coaches felt that other coaches in their league were following the pitch-count rules. While there are guidelines in place to protect the athletes, their importance may not be emphasized enough in some leagues.

Pitch type should also be considered with young pitchers. Although there has not been any evidence showing that breaking pitches lead to injury, Dr. James Andrews, renowned orthopedic surgeon, has recommended that players don't use these pitches until they can shave. He also recommends that players work on their fastball and changeup instead.

Studies have shown that there is a connection between the force with which the ball is thrown and the likelihood of injury in that pitcher. Radar guns are not recommended, as they only encourage pitchers to throw harder than they should. Too much stress is put on developing elbows in young pitchers by throwing too hard, too often. This has led to a rise in ulnar collateral ligament (UCL) reconstruction, also known as Tommy John surgery. Andrews said that whereas he used to perform three to four UCL surgeries per year on high school athletes, he now does three to four per week.

A common misconception about Tommy John surgery is that it makes the athlete throw harder than before the ligament reconstruction. This is sometimes the case in Major League pitchers, but with good reason. Often, these pitchers have been throwing with some degree of pain for years, which can impact velocity and mechanics. A more likely explanation is that following the surgery, a pitcher has time to rest and recover. Throw in an extensive rehabilitation program and you have a pitcher who is healthier than he has been in years. It's not just the reconstruction, but also it's the work that goes into it following the repair.

The most important thing that can be done to decrease overuse injuries in baseball is to be more aware of the factors that increase risk.

Emphasizing adequate rest and recovery now will not only decrease injury but will likely prolong the careers of these Little Leaguers. If a pitcher is overused while he is young, it threatens his ability in the future. If you think your player has the stuff now, just think about the possibility if you keep him or her healthy.